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General NPI Number Information
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NPI Number | 1992448534
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Entity Type | Organization
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Legal Business Name | MAP BEHAVIORAL HEALTH GROUP
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Dates
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Enumeration Date | 04/20/2022
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Last Update Date | 04/20/2022
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Provider Practice Location Address
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Address Line | 343 ELMWOOD AVE
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City | PROVIDENCE
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State | RI
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Zip | 02907-1546
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Country | US
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Telephone | 401-999-7010
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Fax |
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Provider Business Mailing Address
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Address Line | 343 ELMWOOD AVE
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City | PROVIDENCE
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State | RI
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Zip | 02907-1546
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Country | US
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Telephone | 401-999-7010
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Fax |
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Authorized Official
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Title or Position | CEO/EXECUTIVE DIRECTOR
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Name | LIONEL H. FERNANDEZ
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Credential | MSW
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Telephone | 401-999-7010
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 2084A0401X
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Taxonomy Name | Addiction Medicine (Psychiatry & Neurology) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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